Carolyn Tuft starts her morning with a pain pill.
She takes more throughout the day to take the edge off her constant companion: Suffering from a shotgun blast that tore away flesh, nerves and muscles in three places, and the lead poisoning from the buckshot still in her body that leaves her bones throbbing.
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Proposed patient protections
A Food and Drug Administration advisory committee has recommended reclassifying opioids that contain hydrocodone from Schedule III to stricter Schedule II restrictions.
Instead of getting a prescription for up to five refills over six months, Schedule II drugs are limited to a 90-day supply in certain cases. And they require up to monthly visits to a health care provider, instead of every six months or once a year.
Hydrocodone is an ingredient in painkillers including Vicodin and Lortab, meant to treat moderate to moderately severe pain. They’re used for acute, trauma-related and post-surgical pain, including dental procedures, and frequently for chronic pain.
The FDA has also called for public comment on the science of using opioids for chronic, non-cancer pain, noting that their safety and effectiveness as pain relievers has been called into question.
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Prescription overdoses on the rise
Nationally, drug overdose deaths increased for the 11th consecutive year in 2010, according to data released this month by the Centers for Disease Control and Prevention.
More than half of the deaths involved pharmaceuticals. And prescription painkillers were the leading culprit, implicated in three out of four prescription drug overdose deaths.
Utah already has one of the country’s highest drug overdose rates, and the deaths may be creeping back up after large drop.
The number of deaths had declined 28 percent from 2007 to 2010, down to 236 deaths, during a statewide campaign to educate doctors and the public about proper use of pain pills. But the number of deaths rose again in 2011, by 10.
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"I wouldn’t be able to get out of bed or function without it," said Tuft, 50, a victim of the 2007 Trolley Square shootings, where her daughter and four others died.
Roy Bosley lives with a different kind of pain: Memories of arriving at his Ogden home to find his wife of 38 years, Carol, dead from an overdose of the pills she took for back pain.
It was the day before Thanksgiving, Nov. 25, 2009.
"I had been running around the valley looking for bread crumbs for the stuffing she was going to make. The holidays were her big thing," said Bosley, now 65. "It was horrible. My whole world came to an end right there."
If Carol Bosley and Carolyn Tuft illustrate polar ends of an ongoing debate over the safety and effectiveness of opioids, their former doctor, Lynn Webster, is among the physicians whose aggressive prescribing triggered it.
The Utah anesthesiologist has spent the past decade writing and lecturing about how to safely prescribe opioids, as use of the drugs exploded in the U.S. He created a widely used screening tool to identify patients at risk for abusing them. Last week, he spoke to a federal panel about proposed limits on medications containing hydrocodone that he fears might hurt patients like Tuft.
But the 62-year-old is also under federal scrutiny. The U.S. Drug Enforcement Administration is investigating overdose deaths of patients of his former pain clinic. And a U.S. Senate Committee on Finance is examining payments he’s received from opioid manufacturers as president-elect of the industry-backed American Academy of Pain Medicine.
"There’s no area of medicine that’s more challenging today. [As a pain doctor] you’re damned if you do, and you’re damned if you don’t," said Webster, downplaying the investigations. "Everything I have done over the last decade has been about trying to help patients and ensure safety in our field."
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Webster was recently quoted in the Milwaukee Journal Sentinel acknowledging that many as 20 of his former clinic’s patients died of opioid overdoses — which, he said, "has driven me to push for safer prescribing."
On Wednesday he denied saying that.
"Like most practices we had patients who died. There were people who died from cancer, heart and lung disease and people who committed suicide and used their medications to overdose. It’s always a tragedy when that occurs," he said. "All of their care was as good as it could be at the time. If anyone had an adverse outcome we all shared in that tragedy."
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Who benefits? » One expert says the safety precautions Webster promotes — flagging patients at risk for abuse, frequent office visits and urine drug screens — make sense, but haven’t been proven to stop addiction.
"The problem is, in real life practice these things don’t get done consistently and we don’t really know if these precautions work," said Michael Von Korff, an epidemiologist in Seattle and a member of Physicians for Responsible Opioid Prescribing.
The academy and other physician groups "understated the risks and overstated the benefits" of narcotic pain killers, fueling a dramatic rise in opioid prescriptions and overdose deaths, said Korff.
But there’s no evidence these drugs are effective at managing chronic pain and medical opinion is changing, he said. "These are treatments that should be used selectively, with great caution and at low doses."
Indeed, Webster concedes, "opioids are not the best treatment for many people." There aren’t enough long-term studies to show what subset of the population benefits, he said.
But currently, he said, there’s no substitute for the "many people who simply could not live unless they had strong pain relievers."
Tuft, his former patient, is one of those people. "I live on pain medication," she said, noting she shares Webster’s concerns that new restrictions could make the drugs more expensive and difficult to obtain. "I hate that I have to live like that, but it’s just a fact of my life right now."
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